Provider Demographics
NPI:1972805851
Name:FITZGERALD, ROXANNE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7720 W CLARENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-1832
Mailing Address - Country:US
Mailing Address - Phone:773-775-7730
Mailing Address - Fax:
Practice Address - Street 1:7720 W CLARENCE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-1832
Practice Address - Country:US
Practice Address - Phone:773-775-7730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-26
Last Update Date:2010-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.008482367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered